Minimally invasive surgery through right lateral thoracotomy for atrial septal defect combined with atrial fibrillation in adults_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANG Zhaolei ¹ ,  MEI Ju ¹ , TANG Min ¹ , MA Nan ¹ , LIU Hao ¹ , DING Fangbao ¹ , BAO Chunrong ¹ , SHEN Saie ²

1. Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, P.R.China;
2. Department of Anesthesiology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, P.R.China;

Corresponding author：

MEI Ju, Email: ju_mei63@126.com

Keywords：

Atrial fibrillation; atrial septal defect; minimally invasive surgery; bipolar clamp

DOI：

10.7507/1007-4848.201705022

Video：

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Objective To explore the technique of performing minimally invasive Cox Maze Ⅳ procedure by bipolar clamp through right lateral minithoracotomy for atrial septal defect (ASD) combined with atrial fibrillation (AF) in adults. Methods Thirty-five patients (21 males, 14 females with age ranging from 45 to 73 years) with ASD and persistent or long-standing persistent AF received minimally invasive Cox Maze Ⅳ procedure and ASD closure from August 2012 to April 2016 at Department of Cardiothoracic Surgery, Xinhua Hospital. Diameter of left atrium ranged from 39 to 60 mm and left ventricle ejection fraction (LVEF) ranged from 48% to 62%. Diameter of ASD ranged from 20 to 35 mm. Cox-maze Ⅳ procedure was performed through right minithoracotomy entirely by bipolar radiofrequency clamp. Then, mitral or tricuspid valvuloplasty and surgical ASD closure was performed through right minithoracotomy. Results All patients successfully underwent this minimally invasive surgery. No patient needed conversion to sternotomy. The mean cardiopulmonary bypass time was 120.1±14.1 min. The mean aortic cross-clamp time was 79.5±12.2 min. There was no early death or pacemaker implantation perioperatively. The average length of hospital stay was 10.1±2.7 d. At a mean follow-up of 22.8±12.2 months, sinus rhythm was restored in 32 patients (32/35, 91.4%). Cumulative maintenance of normal sinus rhythm without AF recurrence at 2 years postoperatively was 89.1%±6.0%. Conclusion The minimally invasive Cox Maze Ⅳprocedure performed by bipolar clamp through right minithoracotomy is safe, feasible, and effective for adult patients with ASD combined with AF.

Citation： JIANG Zhaolei, MEI Ju, TANG Min, MA Nan, LIU Hao, DING Fangbao, BAO Chunrong, SHEN Saie. Minimally invasive surgery through right lateral thoracotomy for atrial septal defect combined with atrial fibrillation in adults. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(2): 133-137. doi: 10.7507/1007-4848.201705022 Copy

1.	Loomba RS, Chandrasekar S, Sanan P, et al. Association of atrial tachyarrhythmias with atrial septal defect, Ebstein's anomaly and Fontan patients. Expert Rev Cardiovasc Ther, 2011, 9(7): 887-893.
2.	Bouchardy J, Therrien J, Pilote L, et al. Atrial arrhythmias in adults with congenital heart disease. Circulation, 2009, 120(17): 1679-1686.
3.	Silversides CK, Siu SC, McLaughlin PR, et al. Symptomatic atrial arrhythmias and transcatheter closure of atrial septal defects in adult patients. Heart, 2004, 90(10): 1194-1198.
4.	Silversides CK, Haberer K, Siu SC, et al. Predictors of atrial arrhythmias after device closure of secundum type atrial septal defects in adults. Am J Cardiol, 2008, 101(5): 683-687.
5.	Saint LL, Bailey MS, Prasad S, et al. Cox-Maze IV results for patients with lone atrial fibrillation versus concomitant mitral disease. Ann Thorac Surg, 2012, 93(3): 789-794.
6.	Stulak JM, Suri RM, Burkhart HM, et al. Surgical ablation for atrial fibrillation for two decades: are the results of new techniques equivalent to the Cox maze III procedure? J Thorac Cardiovasc Surg, 2014, 147(5): 1478-1486.
7.	Melby SJ, Zierer A, Bailey MS, et al. A new era in the surgical treatment of atrial fibrillation: the impact of ablation technology and lesion set on procedural efficacy. Ann Surg, 2006, 244(4): 583-592.
8.	Dunning J, Nagendran M, Alfieri OR, et al. Guideline for the surgical treatment of atrial fibrillation. Eur J Cardiothorac Surg, 2013, 44(5): 777-791.
9.	Kim JB, Bang JH, Jung SH, et al. Left atrial ablation versus biatrial ablation in the surgical treatment of atrial fibrillation. Ann Thorac Surg, 2011, 92(4): 1397-1404.
10.	姜兆磊, 梅举, 丁芳宝, 等. 二尖瓣手术同期双心房与左心房心房颤动射频消融效果对比. 中华胸心血管外科杂志, 2014, 30(8): 482-485.
11.	Henry L, Ad N. The surgical treatment for atrial fibrillation: ablation technology and surgical approaches. Rambam Maimonides Med J, 2013, 4(3): e0021.
12.	Soni LK, Cedola SR, Cogan J, et al. Right atrial lesions do not improve the efficacy of a complete left atrial lesion set in the surgical treatment of atrial fibrillation, but they do increase procedural morbidity. J Thorac Cardiovasc Surg, 2013, 145(2): 356-361.
13.	姜兆磊, 梅举, 马南, 等. 双心房或单纯右心房射频消融术治疗成人先天性心脏病房间隔缺损合并心房颤动的对比研究. 中国胸心血管外科临床杂志, 2014, 21(3): 296-301.
14.	Basu S, Nagendran M, Maruthappu M. How effective is bipolar radiofrequency ablation for atrial fibrillation during concomitant cardiac surgery? Interact Cardiovasc Thorac Surg, 2012, 15(4): 741-748.
15.	Lawrance CP, Henn MC, Miller JR, et al. A minimally invasive Cox maze IV procedure is as effective as sternotomy while decreasing major morbidity and hospital stay. J Thorac Cardiovasc Surg, 2014, 148(3): 955-961.
16.	Lancaster TS, Melby SJ, Damiano RJ Jr. Minimally invasive surgery for atrial fibrillation. Trends Cardiovasc Med, 2015, 26(3): 268-277.
17.	Garcia-Villarreal OA. Minimally invasive full biatrial Cox maze IV: we are going in the right direction. J Thorac Cardiovasc Surg, 2014, 148(5): 2442.
18.	Ad N, Holmes SD, Massimiano PS, et al. The effect of the Cox-maze procedure for atrial fibrillation concomitant to mitral and tricuspid valve surgery. J Thorac Cardiovasc Surg, 2013, 146(6): 1426-1434.
19.	姜兆磊, 马南, 梅举, 等. 微创右胸切口二尖瓣手术同期双极钳Cox迷宫Ⅳ手术及中期结果. 中华胸心血管外科杂志, 2015, 31(12): 739-742.
20.	Im YM, Kim JB, Yun SC, et al. Arrhythmia surgery for atrial fibrillation associated with atrial septal defect: right-sided maze versus biatrial maze. J Thorac Cardiovasc Surg, 2013, 145(3): 648-654.
21.	梅举, 姜兆磊, 汤敏, 等. 微创心脏瓣膜手术同期双房冷冻消融治疗合并心房颤动[J]. 中国胸心血管外科临床杂志, 2017, 24(1): 25-29.

1. Loomba RS, Chandrasekar S, Sanan P, et al. Association of atrial tachyarrhythmias with atrial septal defect, Ebstein's anomaly and Fontan patients. Expert Rev Cardiovasc Ther, 2011, 9(7): 887-893.
2. Bouchardy J, Therrien J, Pilote L, et al. Atrial arrhythmias in adults with congenital heart disease. Circulation, 2009, 120(17): 1679-1686.
3. Silversides CK, Siu SC, McLaughlin PR, et al. Symptomatic atrial arrhythmias and transcatheter closure of atrial septal defects in adult patients. Heart, 2004, 90(10): 1194-1198.
4. Silversides CK, Haberer K, Siu SC, et al. Predictors of atrial arrhythmias after device closure of secundum type atrial septal defects in adults. Am J Cardiol, 2008, 101(5): 683-687.
5. Saint LL, Bailey MS, Prasad S, et al. Cox-Maze IV results for patients with lone atrial fibrillation versus concomitant mitral disease. Ann Thorac Surg, 2012, 93(3): 789-794.
6. Stulak JM, Suri RM, Burkhart HM, et al. Surgical ablation for atrial fibrillation for two decades: are the results of new techniques equivalent to the Cox maze III procedure? J Thorac Cardiovasc Surg, 2014, 147(5): 1478-1486.
7. Melby SJ, Zierer A, Bailey MS, et al. A new era in the surgical treatment of atrial fibrillation: the impact of ablation technology and lesion set on procedural efficacy. Ann Surg, 2006, 244(4): 583-592.
8. Dunning J, Nagendran M, Alfieri OR, et al. Guideline for the surgical treatment of atrial fibrillation. Eur J Cardiothorac Surg, 2013, 44(5): 777-791.
9. Kim JB, Bang JH, Jung SH, et al. Left atrial ablation versus biatrial ablation in the surgical treatment of atrial fibrillation. Ann Thorac Surg, 2011, 92(4): 1397-1404.
10. 姜兆磊, 梅举, 丁芳宝, 等. 二尖瓣手术同期双心房与左心房心房颤动射频消融效果对比. 中华胸心血管外科杂志, 2014, 30(8): 482-485.
11. Henry L, Ad N. The surgical treatment for atrial fibrillation: ablation technology and surgical approaches. Rambam Maimonides Med J, 2013, 4(3): e0021.
12. Soni LK, Cedola SR, Cogan J, et al. Right atrial lesions do not improve the efficacy of a complete left atrial lesion set in the surgical treatment of atrial fibrillation, but they do increase procedural morbidity. J Thorac Cardiovasc Surg, 2013, 145(2): 356-361.
13. 姜兆磊, 梅举, 马南, 等. 双心房或单纯右心房射频消融术治疗成人先天性心脏病房间隔缺损合并心房颤动的对比研究. 中国胸心血管外科临床杂志, 2014, 21(3): 296-301.
14. Basu S, Nagendran M, Maruthappu M. How effective is bipolar radiofrequency ablation for atrial fibrillation during concomitant cardiac surgery? Interact Cardiovasc Thorac Surg, 2012, 15(4): 741-748.
15. Lawrance CP, Henn MC, Miller JR, et al. A minimally invasive Cox maze IV procedure is as effective as sternotomy while decreasing major morbidity and hospital stay. J Thorac Cardiovasc Surg, 2014, 148(3): 955-961.
16. Lancaster TS, Melby SJ, Damiano RJ Jr. Minimally invasive surgery for atrial fibrillation. Trends Cardiovasc Med, 2015, 26(3): 268-277.
17. Garcia-Villarreal OA. Minimally invasive full biatrial Cox maze IV: we are going in the right direction. J Thorac Cardiovasc Surg, 2014, 148(5): 2442.
18. Ad N, Holmes SD, Massimiano PS, et al. The effect of the Cox-maze procedure for atrial fibrillation concomitant to mitral and tricuspid valve surgery. J Thorac Cardiovasc Surg, 2013, 146(6): 1426-1434.
19. 姜兆磊, 马南, 梅举, 等. 微创右胸切口二尖瓣手术同期双极钳Cox迷宫Ⅳ手术及中期结果. 中华胸心血管外科杂志, 2015, 31(12): 739-742.
20. Im YM, Kim JB, Yun SC, et al. Arrhythmia surgery for atrial fibrillation associated with atrial septal defect: right-sided maze versus biatrial maze. J Thorac Cardiovasc Surg, 2013, 145(3): 648-654.
21. 梅举, 姜兆磊, 汤敏, 等. 微创心脏瓣膜手术同期双房冷冻消融治疗合并心房颤动[J]. 中国胸心血管外科临床杂志, 2017, 24(1): 25-29.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Minimally invasive surgery through right lateral thoracotomy for atrial septal defect combined with atrial fibrillation in adults

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